An analysis of the demand for an assisted living facility in the Stroud, Oklahoma, medical service area

An Analysis of the Demand
for an Assisted Living Facility in the
Stroud, Oklahoma, Medical Service Area
Oklahoma Cooperative Extension Service
Rural Development
Oklahoma State University
Oklahoma Office of Rural Health
OSU Center for Rural Health
Oklahoma State University
August 2010 AE-10028
An Analysis of the Demand for an Assisted Living Facility
in the Stroud, Oklahoma, Medical Service Area
Lara Brooks- Assistant State Extension Specialist, OSU, Stillwater
405-744-4857; FAX 405-744-9835
lara.brooks@okstate.edu
Brian Whitacre - Extension Economist, OSU, Stillwater
405-744-9825
Jack Frye - District Rural Development Specialist, OSU, Ada
580-332-4100
Jessica Riggin – Interim Lincoln County Extension Director, OSU, Chandler
405-258-0560
Corie Kaiser-Assistant Director, Oklahoma Office of Rural Health, Oklahoma City
405-840-6500
Val Schott - Director, Oklahoma Office of Rural Health, Oklahoma City
405-840-6500
Oklahoma Cooperative Extension Service
Rural Development
Oklahoma State University
Oklahoma Office of Rural Health
OSU Center for Rural Health
Oklahoma State University
August 20101
An Analysis of the Demand for an Assisted Living Facility
in the Stroud, Oklahoma, Medical Service Area
This report will examine the need for an assisted living facility in the Stroud, Oklahoma medical service area. This report briefly describes the process decision makers can utilize to help determine the demand for an assisted living facility. Specifically, the study will:
1. Determine the service area and population; and
2. Estimate the number of potential participants in the service area.
No recommendations will be made. The information included in this report is designed to assist local decision-makers in assessing the need and potential for an assisted living facility.
Introduction
The population of the United States continues to age. Those ages 65 and over are making up a larger percentage of the total population. In 2000, the age group of 65 and over accounted for 12.4 percent of the total U.S population and 13.2 percent of the state of Oklahoma’s population. This percentage had increased to 12.6 percent and 13.3 percent respectively, according to 2008 estimates by the U.S. Census Bureau. This increasing trend is extremely evident in rural Oklahoma. Rural areas also tend to have higher percentages of populations aged 65 and over. The U.S. Census Bureau estimates for 2008 indicate that those aged 65 and over account for 14.4 percent of the total population in Lincoln County. This is an increase from 2000 when Lincoln County reported that the 65 and over population accounted for 13.9 percent of the total population. These numbers are expected to continue to increase as the “Baby Boomers” reach closer to retirement. 2
With a growing aging population many questions are raised about long-term care options., particularly in rural area. Traditionally, there have been fewer options for the rural elderly population needing assistance with activities of daily living (ADLs) such as bathing and dressing. Nursing home care or living with a family member, when available, were the only options. In more recent years, assisted living facilities have begun to spread out into rural areas. There are significant differences between assisted living and nursing home care. The U.S. Department of Health and Human Services describes an assisted living facility as an alternative housing option for older adults who may need assistance with dressing, bathing, eating, and toileting, but do not require the intensive medical and nursing care provided in nursing homes. Therefore, those who need assistance with a few ADLs have the option of an assisted living facility instead of nursing home care. Services provided in assisted living facilities may include:
 Three meals a day served in a common dining area;
 Housekeeping services;
 Transportation;
 Assistance with eating, bathing, dressing, toileting, and walking;
 Access to health and medical services
 24-hour security and staff availability
 Emergency call systems for each resident’s unit;
 Health promotion and exercise programs;
 Medication management;
 Personal laundry services; and
 Social and recreational activities
The percentage of residents needing help with ADLs varies per activity. The National Center for Assisted Living estimated that 64 percent of residents needed help bathing, 39 percent needed assistance dressing, 26 percent needed help toileting, 19 percent needed help 3
transferring, and 12 percent of residents needed assistance eating. They also concluded that 87 percent of the current residents need assistance with meal preparation, and 81 percent needed help managing their medications (National Center for Assisted Living, 2009).
Traditionally, a vast majority of assisted living residents do need assistance with ADLs. However, there are a growing number of residents who need no assistance. The 2009 Overview of Assisted Living (American Association of Homes and Services for the Aging “AAHSA” et al., 2009) found that 35 percent of current assisted living residents do not need assistance with any ADLs. These individuals may choose to live in an assisted living facility for convenience or to be located among other seniors with similar interests. In addition, female residents on average needed assistance with 1.7 ADLs, and male residents on average need assistance with 1.3 ADLs. These estimates have decreased from 2006 when males reported needing assistance with an average of 1.9 ADLs, and females reported needing assistance with an average of 2.0 ADLs (AAHSA et al., 2009).
Another major difference in assisted living care versus nursing home care is the cost. Since intensive medical and nursing care is not required for assisted living facilities, there is often a substantial difference in cost. A survey in 2009 completed by MetLife Mature Market Institute found that the national average overall cost for a one-bedroom assisted living facility room was $3,131 per month. This is significantly lower than to the national overall average cost of a one bedroom private room in a nursing facility ($6,661 per month). In Oklahoma, the average monthly rate per patient for a private one bedroom assisted living facility room was $2,503. This compares to the average of $3,923.75 per month for nursing home care in Oklahoma. 4
Much of the funding for one’s stay in an assisted living center largely comes from personal funds. According to the 2009 Overview of Assisted Living (AAHSA et al., 2009), 59.1 percent of the total funds for assisted living are from personal funds, and 9.8 percent are from family assistance. Medicaid accounted for 18.9 percent of funding for residents of an assisted living facility. These statistics are represented in Figure 1, along with other funding sources for assisted living. This heavy reliance on personal funds implies that lower-income individuals may have a hard time paying for assisted living services.
Figure 1. Funding Sources for Residents of Assisted Living Centers
Source: 2009 Overview of Assisted Living
The total number of assisted living facilities in Oklahoma for 2009 reached 121 with 80 located in metropolitan areas, and 41 located in nonmetropolitan areas (Oklahoma State
59.1%
18.9%
9.8%
6.3%
3.8%
1.4%
0.7%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Self
Medicaid
Family
Long-term care insurance
SSI/State Supplement
Unknown
VA5
Department of Health, 2009). There are a total number of 7,312 assisted living facility beds/rooms statewide. The facility size ranges from 5 beds/rooms up to 166 across the state. The average number of beds/rooms for assisted living facilities in a nonmetropolitan area is 49, which is lower than the metropolitan average of 67. This compares to the state average of 60 beds/rooms. Table 1 depicts these results.
Table 1
Number of Assisted Living Facility Beds/Rooms for Oklahoma, Metropolitan Areas, and Nonmetropolitan Areas
Oklahoma State Department of Health, “Directory of Oklahoma Licensed Long Term Care Facilities,” 2009, website: www.health.state.ok.us.
Medical Service Area
Estimating potential participation for an assisted living center requires defining the service area for the facility, identifying the population of the service area and calculating the different age groups within the service area. Figure 2 shows the proposed medical service area with the surrounding assisted living and nursing facilities according to the latest Oklahoma Medical Facilities Directory (April, 2009) obtained from the Oklahoma State Department of Health website. The proposed service area for the Stroud assisted living facility is derived by considering availability of other assisted living facilities and the relative travel distances to the alternative facilities. Note that there are no existing assisted living facilities I the proposed service area depicted in Figure 2. The proposed medical service area includes all of the zip codes shown in Table 2. Table 2 presents the 2000 census estimates and 2000 estimates from
Total
Average
High
Low
State
7,312
60
166
5
Metropolitan
4,848
67
166
5
Nonmetropolitan
2,227
49
124
6 6
ESRI (a different data source) for comparison purposes. Zip code delineations are arbitrary and change frequently resulting in slight differences between the two estimates. Zip Code data is not available from the U.S. Census for 2009. Therefore, population from the 2009 ESRI estimates will be utilized in estimating number of participants. The 2009 ESRI estimated population of the medical service area is 41,922. As is common in this part of the state, most towns included in the analysis have experienced an increase in population since the 2000 ESRI estimates. The largest zip code population in the medical service area is Cushing with an estimated population of 11,177 for 2009. Chandler and Drumright follow with estimated populations of 6,503 and 6,329, respectively.
SOURCE: Oklahoma State Department of Health
Figure 2. Stroud Proposed Service Area for Assisted Living Facility
Denotes Existing Assisted Living Facility
Proposed Service Area
Denotes Existing Nursing Home Facility 7
County
City
Facility
Type
Beds
Lincoln
Stroud, OK
Stroud Health Center South
Nursing Home
58
Lincoln
Chandler, OK
Chandler Nursing Center
Nursing Home
76
Lincoln
Meeker, OK
Meeker Nursing Center
Nursing Home
70
Lincoln
Prague, OK
Parkland Manor Nursing Home
Nursing Home
78
Creek
Drumright, OK
Drumright Nursing Home
Nursing Home
133
Creek
Mannford
Cimarron Pointe Care Center
Nursing Home
108
Logan
Guthrie, OK
Colonial Estates
Nursing Home
91
Logan
Guthrie, OK
Golden Age Nursing Home of Guthrie
Nursing Home
125
Logan
Guthrie, OK
Willow Creek Health Care
Nursing Home
100
Logan
Guthrie, OK
Ash Street Place
Assisted Living
37
Oklahoma
Harrah, OK
Harrah Nursing Center
Nursing Home
100
Payne
Cushing, OK
Linwood Village Nursing & Retirement
Nursing Home
67
Payne
Cushing, OK
Rest Haven Nursing Home
Nursing Home
85
Payne
Perkins, OK
Red Bud Assisted Living
Assisted Living
30
Payne
Stillwater, OK
Grace Living Center
Nursing Home
112
Payne
Stillwater, OK
Westhaven Nursing Home
Nursing Home
125
Payne
Stillwater, OK
Golden Oaks Assisted Living
Assisted Living
124
Payne
Stillwater, OK
Sterling House of Stillwater
Assisted Living
39
Payne
Stillwater, OK
The Renaissance of Stillwater
Assisted Living
76
Payne
Yale, OK
Davis Home Assisted Living
Assisted Living
6
Pottawatomie
McLoud, OK
McLoud Nursing Center
Nursing Home
80
Pottawatomie
Shawnee, OK
Rose Manor Nursing Center
Nursing Home
100
Pottawatomie
Shawnee, OK
Shawnee Care Center
Nursing Home
114
Pottawatomie
Shawnee, OK
Shawnee Colonial Estates Nursing Home
Nursing Home
161
Pottawatomie
Shawnee, OK
The Golden Rule Home
Nursing Home
83
8
Table 2
Population of Stroud Service Area
Medical Service Area
Populations
Population by Zip Code
City
2000 Census
2000 ESRI
2009 ESRI
74079
Stroud
4,896
5,048
5,143
74023
Cushing
12,037
10,915
11,177
74026
Davenport
1,019
986
803
74028
Depew
1,799
1,932
1,906
74030
Drumright
3,830
6,345
6,329
74824
Agra
1,052
1,525
1,504
74834
Chandler
6,896
6,110
6,503
74864
Prague
4,652
4,456
4,609
74869
Sparks
599
295
288
74881
Wellston
3,598
3,702
3,660
Total
40,378
41,314
41,992
% Change from 2000 ESRI
1.5%
SOURCE: U.S. Census Bureau, 2000 Census Data, ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
Tables 3 and 4 divide the total service area population by age groups. Table 2 displays all age groups from 0-19 years of age to 65+. The age group of 65 and over makes up about 16 percent of the total population for the service area with a population of 6,710 for 2009. The largest age group is the 20-44 year range. This group makes up around 32 percent of the total population.
9
Table 3
Population by Age for Proposed Service Area
SOURCE: U.S. Census Bureau, 2000 Census Data, ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
Since potential participation will come from those 65 and above, Table 4 further
describes this population group. The largest percentages of residents 65 and over are aged 65-74 years of age (nearly 52 percent). Individuals in this age group may not currently be looking for assisted living or nursing home care, but may find themselves in need of these services within the next few years.
Table 4
Population 65 and Over for Proposed Service Area
Age
Census 2000
ESRI 2000
% of Total
ESRI 2009
% of Total
65-74
3,302
3,427
51.8
3,475
51.8
75-84
2,223
2,306
34.9
2,341
34.9
85+
849
879
13.3
894
13.3
Total
6,374
6,612
6,710
SOURCE: U.S. Census Bureau, 2000 Census Data, ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
Table 5 offers insight into some basic economic indicators for Lincoln County. According to the Bureau of Economic Analysis for 2008, Lincoln County’s per capita income of
Age
Census 2000
ESRI 2000
% of Total
ESRI 2009
% of Total
0-19
11,641
11,919
28.8
12,087
28.8
20-44
12,961
13,198
31.9
13,389
31.9
45-64
9,402
9,585
23.2
9,736
23.2
65+
6,374
6,612
16.0
6,710
16.0
Total
40,378
41,314
41,922
10
$29,274 was lower than the state average of $35,969 and lower than the national average of $40,166. From the U. S. Census Bureau, the percent of people in poverty in Lincoln County was 14.2 percent in 2008, as compared to 15.7 percent for the state and 13.2 percent nationally. Therefore, the percentage of total people in poverty in Lincoln County was lower than the state but higher than the nation. The percentage of people under age 18 in poverty in 2008 followed similar trends, with Lincoln County being lower than the state but higher than the nation. Another economic indicator for Lincoln County is the total dollar amount of transfer payments. Transfer payments represent that portion of total personal income whose source is state and federal funds. These typically include social security, Medicare, and retirement / disability payments. Total transfer payments for Lincoln County equal $199,015,000. Medical payments (such as Medicare or Medicaid) alone total $78,090,000 or 39.2 percent of total transfer payments. This percentage is less than the state percentage (42.6 percent) and the national percentage (44.0 percent). Transfer payments as a percentage of total personal income is another economic indicator for Lincoln County. In 2008, transfer payments accounted for a total of 21.2 percent of the total personal income. This percentage is higher than both the state (17.7 percent) and the nation (15.3 percent).
11
Table 5
Economic Indicators for Lincoln County,
the State of Oklahoma and the Nation
Indicator
County
State
U.S.
Total Personal Income (2008)
$938,831,000
$131,070,218,000
$12,225,589,000,000
Per Capita Income (2008)
$29,274
$35,969
$40,166
Percentage of People in Poverty (2008)
14.2%
15.7%
13.2%
Percentage of Under 18 in Poverty (2008)
21.4%
22.0%
18.2%
Transfer Dollars (2008)
$199,015,000
$23,242,704,000
$1,875,588,000,000
Medical Benefits Included in
Trasnfer Dollars (2008)
$78,090,000
$9,896,866,000
$824,378,000,000
Medical Benefits as a Percentage
39.2%
42.6%
44.0%
of Transfer Dollars (2008)
Transfer Dollars as Percentage of
21.2%
17.7%
15.3%
Total Personal Income (2008)
SOURCES: 2010 Bureau of Economic Analysis; 2010 U.S. Census Bureau.
Estimating Participation
Tables 6 and 7 estimate possible participation for an assisted living facility in the Stroud Service Area. One factor for estimating the need for assisted living services is the age of the population utilizing the majority of the services. According to the 2009 Overview of Assisted Living, the average assisted living resident was an 87.3 year old female (73.6% of total residents were female) and an 85.7 year old male (26.4% of total residents were male) (AAHSA et al., 2009). For this analysis, the entire 65 and over population will be examined. In addition, only 12.5 percent of the residents surveyed were married or had a significant other; it can be assumed 12
that counting assisted living beds will give an accurate estimate of assisted living residents (AAHSA et al., 2009). While 100 percent occupancy does occur, survey results indicate that on average the occupancy rate is 89.2 percent nationally (AAHSA et al., 2009).
Another criterion for estimating the need for assisted living is the ability to pay for the services. Utilization is determined not only by what people want but by what they can afford. As stated earlier, the average monthly cost for assisted living residents in Oklahoma is $2,503. As shown in Figure 1, private pay (self and family) accounts nearly 70 percent of the total funding for assisted living those residing in assisted living facilities. For the purposes of this study, the assumption will be made that those age 65 and over that are also below the 200% poverty line will not be able to afford assisted living. Therefore, these individuals will be subtracted from the potential number of participants.
The methodology also incorporates an “Assisted living coefficient,” specific to Oklahoma that estimates the number of assisted living residents per 1,000 individuals over the age of 65. Combining data on the total number of Oklahomans over age 65 with Oklahoma Health Department data on the number of assisted living beds allows us to derive several coefficients. There are roughly 480,600 Oklahomans over age 65, and there were 6,819 assisted living beds in Oklahoma in 2009. This suggests that 14.2 out of every 1,000 Oklahomans over age 65 could potentially utilize an assisted living facility. However, this does not take into account the seniors who cannot afford assisted living. Using a 200 % poverty rate of 37.5% leaves 300,400 Oklahomans over 65 who could potentially afford assisted living. Combining this with 6,819 beds suggests that 22.7 out of every 1,000 Oklahomans over 65 AND above 200% poverty typically use assisted facilities. Since there are no existing assisted living facilities 13
in the service area, there will be no need to subtract out current assisted living occupancy within the service area.
In the results that follow, we estimate participation by 1) using the appropriate coefficients denoted above and 2) accounting for poverty considerations. The order in which these are done impacts the estimates, as shown below.
Table 6 displays the results of the possible participation. The total population aged 65 years and over for the service area depicted in Figure 2 is 6,710. Line B shows that 2,516 of the total fall below the 200 percent poverty line, so they are subtracted from the total leaving 4,194 possible participants. Next, the coefficient for Oklahoma assisted living usage per 1,000 individuals (22.7) is then applied to yield 95 possible participants. As stated earlier, not all of these facilities are at 100 percent occupancy, so the national occupancy rate of 89.2 is applied in line F to yield a total of 85 participants.
14
Table 6
Estimating Potential Participation, Stroud, Oklahoma
A.
Population Age 65+ Years the Service Area1
6,710
B.
Less 200% Poverty Rate (37.5%)2
2,516
C.
Service Area without Poverty
4,194
D.
Oklahoma Assisted Living Coefficient per 1,0003
22.1
E.
Possible Stroud Area Assisted Living Residents
93
F.
Possible Stroud Area Assisted Living Residents after National Occupancy Rate (89.2%)4
83
1 U.S. Census Bureau, 2000 Census Data, ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
2 Poverty Rate (200% poverty level) from U.S. Census Bureau, 2008 Current Population Survey, Annual Social and Economic Supplement, for 65 years and over (37.5%)
3 Proportion of Oklahoma over 65 population (U.S. Census Bureau, 2010) and the number of Assisted Living Beds in Oklahoma (Oklahoma Department of Health Directory, 2009)
4 2009 Overview of Assisted Living
Table 7 uses similar methodology as in Table 6 by estimating possible participation. Therefore, the service area population is the same as previous at 6,710. In this table, line B displays the Oklahoma assisted living coefficient per 1,000 individuals. This coefficient varies from Table 6 because poverty is not reflected in the coefficient. After applying the coefficient, there are an estimated 95 individuals in the service area BEFORE accounting for those under 200% of poverty. The same poverty rate of 200 percent is then applied to the current 95 individuals in Line D. This suggests that 59 individuals in the service area are above the poverty threshold and could participate in the assisted living facility. The national occupancy rate of 15
89.2 is then applied (since most often not all assisted living facilities are at full capacity). Line F displays that 53 individuals in the service area could be possible participants given the listed assumptions.
Since there is a variation in the two estimates, it is most likely best to assume that the true potential local usage would fall somewhere between 83 and 53 potential participants for the service area.
Table 7
Estimating Potential Participation, Stroud, Oklahoma
A.
Population Age 65+ Years the Service Area1
6,710
B.
Oklahoma Assisted Living Coefficient per 1,0002
14.2
C.
Population 65+ Assisted Living Usage
95
D.
Less 200% Poverty Rate (37.5%)3
36
E.
Service Area without Poverty
59
F.
Possible Sroud Area Assisted Living Residents after National Occupancy Rate (89.2%)4
53
1 ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
2 Proportion of Oklahoma over 65 population (U.S. Census Bureau, 2010) and the number of Assisted Living Beds in Oklahoma (Oklahoma Department of Health Directory, 2009)
3 Poverty Rate (200% poverty level) from U.S. Census Bureau, 2008 Current Population Survey, Annual Social and Economic Supplement, for 65 years and over (37.5%)
4 2009 Overview of Assisted Living
16
In addition to examining two methodologies, there is the potential for variance in the depicted service area. The original service area includes the Drumright, Depew, and Cushing zip codes. These three communities are located outside of Lincoln County. Drumright and Cushing both currently have at least one nursing home in each of their zip codes. There are also current assisted living facilities located in each of their counties (Sapulpa has a 32 bed facility). Tables 8 and 9 follow the same methodology laid out in Tables 6 and 7 with the zip codes of Drumright, 73030; Depew, 74028; and Cushing, 74023 removed from the analysis.
Table 8 follows the same methodology as Table 6. The new service area population over the age of 65 is 3,380. The same poverty rate for 200 percent poverty is applied leaving 2,113 individuals over the age of 65 who are above the poverty threshold. The Oklahoma assisted living coefficient of 22.1 per 1,000 population is applied (this coefficient assumes poverty for the state). A total of 43 potential participants is then derived after applying the national occupancy rate of 89.2.
17
Table 8
Estimating Potential Participation, Stroud, Oklahoma, without Drumright (73030) Depew (74028), and Cushing (74023)
A.
Population Age 65+ Years the Service Area1
3,380
B.
Less 200% Poverty Rate (37.5%)2
1,268
C.
Service Area without Poverty
2,113
D.
Oklahoma Assisted Living Coefficient per 1,000 population3
22.7
E.
Possible Stroud Area Assisted Living Residents
48
F.
Possible Sroud Area Assisted Living Residents after National Occupancy Rate (89.2%)4
43
1 ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
2 Poverty Rate (200% poverty level) from U.S. Census Bureau, 2008 Current Population Survey, Annual Social and Economic Supplement, for 65 years and over (37.5%)
3 Proportion of Oklahoma over 65 population (U.S. Census Bureau, 2010) and the number of Assisted Living Beds in Oklahoma (Oklahoma Department of Health Directory, 2009)
4 2009 Overview of Assisted Living
Table 9 resembles Table 7 in methodology. The only difference is the smaller service area of 3,380 individuals over the age of 65. After all assumptions have been placed on the service area population, a total of 27 possible participants is yielded. As stated earlier, since there is such a spread in number of possible participants, it is most likely that the best estimate lies between 43 and 27 participants.
18
Table 9
Estimating Potential Participation, Stroud, Oklahoma, without Drumright (73030), Depew (74028), and Cushing (74023)
A.
Population Age 65+ Years the Service Area1
3,380
B.
Oklahoma Assisted Living Coefficient per 1,000 population2
14.2
C.
Population 65+ Assisted Living Usage
48
D.
Less 200% Poverty Rate (37.5%)3
18
E.
Service Area without Poverty
30
F.
Possible Sroud Area Assisted Living Residents after National Occupancy Rate (89.2%)4
27
1 ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
2 Proportion of Oklahoma over 65 population (U.S. Cenus Bureau, 2010) and the number of Assisted Living Beds in Oklahoma (Oklahoma Department of Health Directory, 2009)
3 Poverty Rate (200% poverty level) from U.S. Census Bureau, 2008 Current Population Sruvey, Annual Social and Economic Supplement, for 65 years and over (37.5%)
4 2009 Overview of Assisted Living
As stated throughout the analysis, many assumptions have been made regarding assisted living usage in Oklahoma and Lincoln County. There are no existing facilities. Therefore, there is no need to determine current occupancy of existing assisted living facilities. It would be beneficial for local leadership to consider current occupancy and trends of nursing home occupancy in Lincoln County and the service area. Oftentimes, when exploring potential usage of a new service, it can be viewed as best to keep conservative estimates. The results from Tables 8 and 9 (42-27 possible participants) might be most fitting for the current situation.
19
Summary
Many assumptions have been made in the preceding analysis. These include items that may change such as the population of the service area or service area delineation. For example, the service area depicted here may change due to the exit or entry of assisted living centers or nursing homes. Should this occur, revised estimates of potential participants and service area should be made.
An assisted living center can be very costly to start up and staff. Therefore, all assumptions should be closely examined by local decision-makers to verify that they reflect local conditions. Local data should be included when available. The next step in this analysis should be to consider the costs associated with setting up and running an assisted living center. Decision makers can then determine whether the potential demand and associated revenue outweigh the costs of setting up and maintaining the facility. If further analysis is needed, please contact the authors on the cover page or your county extension office listed on the cover page of this document.20
References
Adams, PF, Lucas, JW, Barnes, PM. Summary of Health Statistics for the U.S. Population: National Health Interview Survey, 2006 National Center for Health Statistics. Vital Health Stat 10(236). 2008.
American Association of Homes and Services for the Aging, American Seniors Housing Association, Assisted Living Federation of America, National Center for Assisted Living, and National Investment Center for the Seniors Housing & Care Industry. 2009. Overview of Assisted Living Facilities. Stratton Publishing and Marketing, Inc. Alexandria, VA.
ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
MetLife Mature Market Institute. 2009. Market Survey of Long-Term Care Costs: The 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services and Home Care Costs. http://www.metlife.com/assets/cao/mmi/publications/studies/ Accessed: January 2010.
National Center for Assisted Living, “Assisted Living Resident Profile,” 2009, website: www.ncal.org. Accessed: January 2010.
Oklahoma State Department of Health, “Directory of Oklahoma Licensed Long Term Care Facilities,” 2009, website: www.health.state.ok.us. Accessed: January 2010
Shelton, R.D., St. Clair, C., Doeksen, G.A., and V. Schott. 2003. A Systems Development Guide for Rural Assisted Living Facilities. Stillwater, OK: Oklahoma State University.
U.S. Bureau of the Census, 2010, website: www.census.gov. Accessed: July 2010.
U.S. Bureau of Economic Analysis, 2010 website: www.bea.gov.: Accessed: July 2010.
U.S. Department of Health and Human Services, Administration on Aging, Fact Sheet: Assisted Living. 2009, website: www.aoa.gov. Accessed: March 2009

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An Analysis of the Demand
for an Assisted Living Facility in the
Stroud, Oklahoma, Medical Service Area
Oklahoma Cooperative Extension Service
Rural Development
Oklahoma State University
Oklahoma Office of Rural Health
OSU Center for Rural Health
Oklahoma State University
August 2010 AE-10028
An Analysis of the Demand for an Assisted Living Facility
in the Stroud, Oklahoma, Medical Service Area
Lara Brooks- Assistant State Extension Specialist, OSU, Stillwater
405-744-4857; FAX 405-744-9835
lara.brooks@okstate.edu
Brian Whitacre - Extension Economist, OSU, Stillwater
405-744-9825
Jack Frye - District Rural Development Specialist, OSU, Ada
580-332-4100
Jessica Riggin – Interim Lincoln County Extension Director, OSU, Chandler
405-258-0560
Corie Kaiser-Assistant Director, Oklahoma Office of Rural Health, Oklahoma City
405-840-6500
Val Schott - Director, Oklahoma Office of Rural Health, Oklahoma City
405-840-6500
Oklahoma Cooperative Extension Service
Rural Development
Oklahoma State University
Oklahoma Office of Rural Health
OSU Center for Rural Health
Oklahoma State University
August 20101
An Analysis of the Demand for an Assisted Living Facility
in the Stroud, Oklahoma, Medical Service Area
This report will examine the need for an assisted living facility in the Stroud, Oklahoma medical service area. This report briefly describes the process decision makers can utilize to help determine the demand for an assisted living facility. Specifically, the study will:
1. Determine the service area and population; and
2. Estimate the number of potential participants in the service area.
No recommendations will be made. The information included in this report is designed to assist local decision-makers in assessing the need and potential for an assisted living facility.
Introduction
The population of the United States continues to age. Those ages 65 and over are making up a larger percentage of the total population. In 2000, the age group of 65 and over accounted for 12.4 percent of the total U.S population and 13.2 percent of the state of Oklahoma’s population. This percentage had increased to 12.6 percent and 13.3 percent respectively, according to 2008 estimates by the U.S. Census Bureau. This increasing trend is extremely evident in rural Oklahoma. Rural areas also tend to have higher percentages of populations aged 65 and over. The U.S. Census Bureau estimates for 2008 indicate that those aged 65 and over account for 14.4 percent of the total population in Lincoln County. This is an increase from 2000 when Lincoln County reported that the 65 and over population accounted for 13.9 percent of the total population. These numbers are expected to continue to increase as the “Baby Boomers” reach closer to retirement. 2
With a growing aging population many questions are raised about long-term care options., particularly in rural area. Traditionally, there have been fewer options for the rural elderly population needing assistance with activities of daily living (ADLs) such as bathing and dressing. Nursing home care or living with a family member, when available, were the only options. In more recent years, assisted living facilities have begun to spread out into rural areas. There are significant differences between assisted living and nursing home care. The U.S. Department of Health and Human Services describes an assisted living facility as an alternative housing option for older adults who may need assistance with dressing, bathing, eating, and toileting, but do not require the intensive medical and nursing care provided in nursing homes. Therefore, those who need assistance with a few ADLs have the option of an assisted living facility instead of nursing home care. Services provided in assisted living facilities may include:
 Three meals a day served in a common dining area;
 Housekeeping services;
 Transportation;
 Assistance with eating, bathing, dressing, toileting, and walking;
 Access to health and medical services
 24-hour security and staff availability
 Emergency call systems for each resident’s unit;
 Health promotion and exercise programs;
 Medication management;
 Personal laundry services; and
 Social and recreational activities
The percentage of residents needing help with ADLs varies per activity. The National Center for Assisted Living estimated that 64 percent of residents needed help bathing, 39 percent needed assistance dressing, 26 percent needed help toileting, 19 percent needed help 3
transferring, and 12 percent of residents needed assistance eating. They also concluded that 87 percent of the current residents need assistance with meal preparation, and 81 percent needed help managing their medications (National Center for Assisted Living, 2009).
Traditionally, a vast majority of assisted living residents do need assistance with ADLs. However, there are a growing number of residents who need no assistance. The 2009 Overview of Assisted Living (American Association of Homes and Services for the Aging “AAHSA” et al., 2009) found that 35 percent of current assisted living residents do not need assistance with any ADLs. These individuals may choose to live in an assisted living facility for convenience or to be located among other seniors with similar interests. In addition, female residents on average needed assistance with 1.7 ADLs, and male residents on average need assistance with 1.3 ADLs. These estimates have decreased from 2006 when males reported needing assistance with an average of 1.9 ADLs, and females reported needing assistance with an average of 2.0 ADLs (AAHSA et al., 2009).
Another major difference in assisted living care versus nursing home care is the cost. Since intensive medical and nursing care is not required for assisted living facilities, there is often a substantial difference in cost. A survey in 2009 completed by MetLife Mature Market Institute found that the national average overall cost for a one-bedroom assisted living facility room was $3,131 per month. This is significantly lower than to the national overall average cost of a one bedroom private room in a nursing facility ($6,661 per month). In Oklahoma, the average monthly rate per patient for a private one bedroom assisted living facility room was $2,503. This compares to the average of $3,923.75 per month for nursing home care in Oklahoma. 4
Much of the funding for one’s stay in an assisted living center largely comes from personal funds. According to the 2009 Overview of Assisted Living (AAHSA et al., 2009), 59.1 percent of the total funds for assisted living are from personal funds, and 9.8 percent are from family assistance. Medicaid accounted for 18.9 percent of funding for residents of an assisted living facility. These statistics are represented in Figure 1, along with other funding sources for assisted living. This heavy reliance on personal funds implies that lower-income individuals may have a hard time paying for assisted living services.
Figure 1. Funding Sources for Residents of Assisted Living Centers
Source: 2009 Overview of Assisted Living
The total number of assisted living facilities in Oklahoma for 2009 reached 121 with 80 located in metropolitan areas, and 41 located in nonmetropolitan areas (Oklahoma State
59.1%
18.9%
9.8%
6.3%
3.8%
1.4%
0.7%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Self
Medicaid
Family
Long-term care insurance
SSI/State Supplement
Unknown
VA5
Department of Health, 2009). There are a total number of 7,312 assisted living facility beds/rooms statewide. The facility size ranges from 5 beds/rooms up to 166 across the state. The average number of beds/rooms for assisted living facilities in a nonmetropolitan area is 49, which is lower than the metropolitan average of 67. This compares to the state average of 60 beds/rooms. Table 1 depicts these results.
Table 1
Number of Assisted Living Facility Beds/Rooms for Oklahoma, Metropolitan Areas, and Nonmetropolitan Areas
Oklahoma State Department of Health, “Directory of Oklahoma Licensed Long Term Care Facilities,” 2009, website: www.health.state.ok.us.
Medical Service Area
Estimating potential participation for an assisted living center requires defining the service area for the facility, identifying the population of the service area and calculating the different age groups within the service area. Figure 2 shows the proposed medical service area with the surrounding assisted living and nursing facilities according to the latest Oklahoma Medical Facilities Directory (April, 2009) obtained from the Oklahoma State Department of Health website. The proposed service area for the Stroud assisted living facility is derived by considering availability of other assisted living facilities and the relative travel distances to the alternative facilities. Note that there are no existing assisted living facilities I the proposed service area depicted in Figure 2. The proposed medical service area includes all of the zip codes shown in Table 2. Table 2 presents the 2000 census estimates and 2000 estimates from
Total
Average
High
Low
State
7,312
60
166
5
Metropolitan
4,848
67
166
5
Nonmetropolitan
2,227
49
124
6 6
ESRI (a different data source) for comparison purposes. Zip code delineations are arbitrary and change frequently resulting in slight differences between the two estimates. Zip Code data is not available from the U.S. Census for 2009. Therefore, population from the 2009 ESRI estimates will be utilized in estimating number of participants. The 2009 ESRI estimated population of the medical service area is 41,922. As is common in this part of the state, most towns included in the analysis have experienced an increase in population since the 2000 ESRI estimates. The largest zip code population in the medical service area is Cushing with an estimated population of 11,177 for 2009. Chandler and Drumright follow with estimated populations of 6,503 and 6,329, respectively.
SOURCE: Oklahoma State Department of Health
Figure 2. Stroud Proposed Service Area for Assisted Living Facility
Denotes Existing Assisted Living Facility
Proposed Service Area
Denotes Existing Nursing Home Facility 7
County
City
Facility
Type
Beds
Lincoln
Stroud, OK
Stroud Health Center South
Nursing Home
58
Lincoln
Chandler, OK
Chandler Nursing Center
Nursing Home
76
Lincoln
Meeker, OK
Meeker Nursing Center
Nursing Home
70
Lincoln
Prague, OK
Parkland Manor Nursing Home
Nursing Home
78
Creek
Drumright, OK
Drumright Nursing Home
Nursing Home
133
Creek
Mannford
Cimarron Pointe Care Center
Nursing Home
108
Logan
Guthrie, OK
Colonial Estates
Nursing Home
91
Logan
Guthrie, OK
Golden Age Nursing Home of Guthrie
Nursing Home
125
Logan
Guthrie, OK
Willow Creek Health Care
Nursing Home
100
Logan
Guthrie, OK
Ash Street Place
Assisted Living
37
Oklahoma
Harrah, OK
Harrah Nursing Center
Nursing Home
100
Payne
Cushing, OK
Linwood Village Nursing & Retirement
Nursing Home
67
Payne
Cushing, OK
Rest Haven Nursing Home
Nursing Home
85
Payne
Perkins, OK
Red Bud Assisted Living
Assisted Living
30
Payne
Stillwater, OK
Grace Living Center
Nursing Home
112
Payne
Stillwater, OK
Westhaven Nursing Home
Nursing Home
125
Payne
Stillwater, OK
Golden Oaks Assisted Living
Assisted Living
124
Payne
Stillwater, OK
Sterling House of Stillwater
Assisted Living
39
Payne
Stillwater, OK
The Renaissance of Stillwater
Assisted Living
76
Payne
Yale, OK
Davis Home Assisted Living
Assisted Living
6
Pottawatomie
McLoud, OK
McLoud Nursing Center
Nursing Home
80
Pottawatomie
Shawnee, OK
Rose Manor Nursing Center
Nursing Home
100
Pottawatomie
Shawnee, OK
Shawnee Care Center
Nursing Home
114
Pottawatomie
Shawnee, OK
Shawnee Colonial Estates Nursing Home
Nursing Home
161
Pottawatomie
Shawnee, OK
The Golden Rule Home
Nursing Home
83
8
Table 2
Population of Stroud Service Area
Medical Service Area
Populations
Population by Zip Code
City
2000 Census
2000 ESRI
2009 ESRI
74079
Stroud
4,896
5,048
5,143
74023
Cushing
12,037
10,915
11,177
74026
Davenport
1,019
986
803
74028
Depew
1,799
1,932
1,906
74030
Drumright
3,830
6,345
6,329
74824
Agra
1,052
1,525
1,504
74834
Chandler
6,896
6,110
6,503
74864
Prague
4,652
4,456
4,609
74869
Sparks
599
295
288
74881
Wellston
3,598
3,702
3,660
Total
40,378
41,314
41,992
% Change from 2000 ESRI
1.5%
SOURCE: U.S. Census Bureau, 2000 Census Data, ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
Tables 3 and 4 divide the total service area population by age groups. Table 2 displays all age groups from 0-19 years of age to 65+. The age group of 65 and over makes up about 16 percent of the total population for the service area with a population of 6,710 for 2009. The largest age group is the 20-44 year range. This group makes up around 32 percent of the total population.
9
Table 3
Population by Age for Proposed Service Area
SOURCE: U.S. Census Bureau, 2000 Census Data, ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
Since potential participation will come from those 65 and above, Table 4 further
describes this population group. The largest percentages of residents 65 and over are aged 65-74 years of age (nearly 52 percent). Individuals in this age group may not currently be looking for assisted living or nursing home care, but may find themselves in need of these services within the next few years.
Table 4
Population 65 and Over for Proposed Service Area
Age
Census 2000
ESRI 2000
% of Total
ESRI 2009
% of Total
65-74
3,302
3,427
51.8
3,475
51.8
75-84
2,223
2,306
34.9
2,341
34.9
85+
849
879
13.3
894
13.3
Total
6,374
6,612
6,710
SOURCE: U.S. Census Bureau, 2000 Census Data, ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
Table 5 offers insight into some basic economic indicators for Lincoln County. According to the Bureau of Economic Analysis for 2008, Lincoln County’s per capita income of
Age
Census 2000
ESRI 2000
% of Total
ESRI 2009
% of Total
0-19
11,641
11,919
28.8
12,087
28.8
20-44
12,961
13,198
31.9
13,389
31.9
45-64
9,402
9,585
23.2
9,736
23.2
65+
6,374
6,612
16.0
6,710
16.0
Total
40,378
41,314
41,922
10
$29,274 was lower than the state average of $35,969 and lower than the national average of $40,166. From the U. S. Census Bureau, the percent of people in poverty in Lincoln County was 14.2 percent in 2008, as compared to 15.7 percent for the state and 13.2 percent nationally. Therefore, the percentage of total people in poverty in Lincoln County was lower than the state but higher than the nation. The percentage of people under age 18 in poverty in 2008 followed similar trends, with Lincoln County being lower than the state but higher than the nation. Another economic indicator for Lincoln County is the total dollar amount of transfer payments. Transfer payments represent that portion of total personal income whose source is state and federal funds. These typically include social security, Medicare, and retirement / disability payments. Total transfer payments for Lincoln County equal $199,015,000. Medical payments (such as Medicare or Medicaid) alone total $78,090,000 or 39.2 percent of total transfer payments. This percentage is less than the state percentage (42.6 percent) and the national percentage (44.0 percent). Transfer payments as a percentage of total personal income is another economic indicator for Lincoln County. In 2008, transfer payments accounted for a total of 21.2 percent of the total personal income. This percentage is higher than both the state (17.7 percent) and the nation (15.3 percent).
11
Table 5
Economic Indicators for Lincoln County,
the State of Oklahoma and the Nation
Indicator
County
State
U.S.
Total Personal Income (2008)
$938,831,000
$131,070,218,000
$12,225,589,000,000
Per Capita Income (2008)
$29,274
$35,969
$40,166
Percentage of People in Poverty (2008)
14.2%
15.7%
13.2%
Percentage of Under 18 in Poverty (2008)
21.4%
22.0%
18.2%
Transfer Dollars (2008)
$199,015,000
$23,242,704,000
$1,875,588,000,000
Medical Benefits Included in
Trasnfer Dollars (2008)
$78,090,000
$9,896,866,000
$824,378,000,000
Medical Benefits as a Percentage
39.2%
42.6%
44.0%
of Transfer Dollars (2008)
Transfer Dollars as Percentage of
21.2%
17.7%
15.3%
Total Personal Income (2008)
SOURCES: 2010 Bureau of Economic Analysis; 2010 U.S. Census Bureau.
Estimating Participation
Tables 6 and 7 estimate possible participation for an assisted living facility in the Stroud Service Area. One factor for estimating the need for assisted living services is the age of the population utilizing the majority of the services. According to the 2009 Overview of Assisted Living, the average assisted living resident was an 87.3 year old female (73.6% of total residents were female) and an 85.7 year old male (26.4% of total residents were male) (AAHSA et al., 2009). For this analysis, the entire 65 and over population will be examined. In addition, only 12.5 percent of the residents surveyed were married or had a significant other; it can be assumed 12
that counting assisted living beds will give an accurate estimate of assisted living residents (AAHSA et al., 2009). While 100 percent occupancy does occur, survey results indicate that on average the occupancy rate is 89.2 percent nationally (AAHSA et al., 2009).
Another criterion for estimating the need for assisted living is the ability to pay for the services. Utilization is determined not only by what people want but by what they can afford. As stated earlier, the average monthly cost for assisted living residents in Oklahoma is $2,503. As shown in Figure 1, private pay (self and family) accounts nearly 70 percent of the total funding for assisted living those residing in assisted living facilities. For the purposes of this study, the assumption will be made that those age 65 and over that are also below the 200% poverty line will not be able to afford assisted living. Therefore, these individuals will be subtracted from the potential number of participants.
The methodology also incorporates an “Assisted living coefficient,” specific to Oklahoma that estimates the number of assisted living residents per 1,000 individuals over the age of 65. Combining data on the total number of Oklahomans over age 65 with Oklahoma Health Department data on the number of assisted living beds allows us to derive several coefficients. There are roughly 480,600 Oklahomans over age 65, and there were 6,819 assisted living beds in Oklahoma in 2009. This suggests that 14.2 out of every 1,000 Oklahomans over age 65 could potentially utilize an assisted living facility. However, this does not take into account the seniors who cannot afford assisted living. Using a 200 % poverty rate of 37.5% leaves 300,400 Oklahomans over 65 who could potentially afford assisted living. Combining this with 6,819 beds suggests that 22.7 out of every 1,000 Oklahomans over 65 AND above 200% poverty typically use assisted facilities. Since there are no existing assisted living facilities 13
in the service area, there will be no need to subtract out current assisted living occupancy within the service area.
In the results that follow, we estimate participation by 1) using the appropriate coefficients denoted above and 2) accounting for poverty considerations. The order in which these are done impacts the estimates, as shown below.
Table 6 displays the results of the possible participation. The total population aged 65 years and over for the service area depicted in Figure 2 is 6,710. Line B shows that 2,516 of the total fall below the 200 percent poverty line, so they are subtracted from the total leaving 4,194 possible participants. Next, the coefficient for Oklahoma assisted living usage per 1,000 individuals (22.7) is then applied to yield 95 possible participants. As stated earlier, not all of these facilities are at 100 percent occupancy, so the national occupancy rate of 89.2 is applied in line F to yield a total of 85 participants.
14
Table 6
Estimating Potential Participation, Stroud, Oklahoma
A.
Population Age 65+ Years the Service Area1
6,710
B.
Less 200% Poverty Rate (37.5%)2
2,516
C.
Service Area without Poverty
4,194
D.
Oklahoma Assisted Living Coefficient per 1,0003
22.1
E.
Possible Stroud Area Assisted Living Residents
93
F.
Possible Stroud Area Assisted Living Residents after National Occupancy Rate (89.2%)4
83
1 U.S. Census Bureau, 2000 Census Data, ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
2 Poverty Rate (200% poverty level) from U.S. Census Bureau, 2008 Current Population Survey, Annual Social and Economic Supplement, for 65 years and over (37.5%)
3 Proportion of Oklahoma over 65 population (U.S. Census Bureau, 2010) and the number of Assisted Living Beds in Oklahoma (Oklahoma Department of Health Directory, 2009)
4 2009 Overview of Assisted Living
Table 7 uses similar methodology as in Table 6 by estimating possible participation. Therefore, the service area population is the same as previous at 6,710. In this table, line B displays the Oklahoma assisted living coefficient per 1,000 individuals. This coefficient varies from Table 6 because poverty is not reflected in the coefficient. After applying the coefficient, there are an estimated 95 individuals in the service area BEFORE accounting for those under 200% of poverty. The same poverty rate of 200 percent is then applied to the current 95 individuals in Line D. This suggests that 59 individuals in the service area are above the poverty threshold and could participate in the assisted living facility. The national occupancy rate of 15
89.2 is then applied (since most often not all assisted living facilities are at full capacity). Line F displays that 53 individuals in the service area could be possible participants given the listed assumptions.
Since there is a variation in the two estimates, it is most likely best to assume that the true potential local usage would fall somewhere between 83 and 53 potential participants for the service area.
Table 7
Estimating Potential Participation, Stroud, Oklahoma
A.
Population Age 65+ Years the Service Area1
6,710
B.
Oklahoma Assisted Living Coefficient per 1,0002
14.2
C.
Population 65+ Assisted Living Usage
95
D.
Less 200% Poverty Rate (37.5%)3
36
E.
Service Area without Poverty
59
F.
Possible Sroud Area Assisted Living Residents after National Occupancy Rate (89.2%)4
53
1 ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
2 Proportion of Oklahoma over 65 population (U.S. Census Bureau, 2010) and the number of Assisted Living Beds in Oklahoma (Oklahoma Department of Health Directory, 2009)
3 Poverty Rate (200% poverty level) from U.S. Census Bureau, 2008 Current Population Survey, Annual Social and Economic Supplement, for 65 years and over (37.5%)
4 2009 Overview of Assisted Living
16
In addition to examining two methodologies, there is the potential for variance in the depicted service area. The original service area includes the Drumright, Depew, and Cushing zip codes. These three communities are located outside of Lincoln County. Drumright and Cushing both currently have at least one nursing home in each of their zip codes. There are also current assisted living facilities located in each of their counties (Sapulpa has a 32 bed facility). Tables 8 and 9 follow the same methodology laid out in Tables 6 and 7 with the zip codes of Drumright, 73030; Depew, 74028; and Cushing, 74023 removed from the analysis.
Table 8 follows the same methodology as Table 6. The new service area population over the age of 65 is 3,380. The same poverty rate for 200 percent poverty is applied leaving 2,113 individuals over the age of 65 who are above the poverty threshold. The Oklahoma assisted living coefficient of 22.1 per 1,000 population is applied (this coefficient assumes poverty for the state). A total of 43 potential participants is then derived after applying the national occupancy rate of 89.2.
17
Table 8
Estimating Potential Participation, Stroud, Oklahoma, without Drumright (73030) Depew (74028), and Cushing (74023)
A.
Population Age 65+ Years the Service Area1
3,380
B.
Less 200% Poverty Rate (37.5%)2
1,268
C.
Service Area without Poverty
2,113
D.
Oklahoma Assisted Living Coefficient per 1,000 population3
22.7
E.
Possible Stroud Area Assisted Living Residents
48
F.
Possible Sroud Area Assisted Living Residents after National Occupancy Rate (89.2%)4
43
1 ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
2 Poverty Rate (200% poverty level) from U.S. Census Bureau, 2008 Current Population Survey, Annual Social and Economic Supplement, for 65 years and over (37.5%)
3 Proportion of Oklahoma over 65 population (U.S. Census Bureau, 2010) and the number of Assisted Living Beds in Oklahoma (Oklahoma Department of Health Directory, 2009)
4 2009 Overview of Assisted Living
Table 9 resembles Table 7 in methodology. The only difference is the smaller service area of 3,380 individuals over the age of 65. After all assumptions have been placed on the service area population, a total of 27 possible participants is yielded. As stated earlier, since there is such a spread in number of possible participants, it is most likely that the best estimate lies between 43 and 27 participants.
18
Table 9
Estimating Potential Participation, Stroud, Oklahoma, without Drumright (73030), Depew (74028), and Cushing (74023)
A.
Population Age 65+ Years the Service Area1
3,380
B.
Oklahoma Assisted Living Coefficient per 1,000 population2
14.2
C.
Population 65+ Assisted Living Usage
48
D.
Less 200% Poverty Rate (37.5%)3
18
E.
Service Area without Poverty
30
F.
Possible Sroud Area Assisted Living Residents after National Occupancy Rate (89.2%)4
27
1 ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
2 Proportion of Oklahoma over 65 population (U.S. Cenus Bureau, 2010) and the number of Assisted Living Beds in Oklahoma (Oklahoma Department of Health Directory, 2009)
3 Poverty Rate (200% poverty level) from U.S. Census Bureau, 2008 Current Population Sruvey, Annual Social and Economic Supplement, for 65 years and over (37.5%)
4 2009 Overview of Assisted Living
As stated throughout the analysis, many assumptions have been made regarding assisted living usage in Oklahoma and Lincoln County. There are no existing facilities. Therefore, there is no need to determine current occupancy of existing assisted living facilities. It would be beneficial for local leadership to consider current occupancy and trends of nursing home occupancy in Lincoln County and the service area. Oftentimes, when exploring potential usage of a new service, it can be viewed as best to keep conservative estimates. The results from Tables 8 and 9 (42-27 possible participants) might be most fitting for the current situation.
19
Summary
Many assumptions have been made in the preceding analysis. These include items that may change such as the population of the service area or service area delineation. For example, the service area depicted here may change due to the exit or entry of assisted living centers or nursing homes. Should this occur, revised estimates of potential participants and service area should be made.
An assisted living center can be very costly to start up and staff. Therefore, all assumptions should be closely examined by local decision-makers to verify that they reflect local conditions. Local data should be included when available. The next step in this analysis should be to consider the costs associated with setting up and running an assisted living center. Decision makers can then determine whether the potential demand and associated revenue outweigh the costs of setting up and maintaining the facility. If further analysis is needed, please contact the authors on the cover page or your county extension office listed on the cover page of this document.20
References
Adams, PF, Lucas, JW, Barnes, PM. Summary of Health Statistics for the U.S. Population: National Health Interview Survey, 2006 National Center for Health Statistics. Vital Health Stat 10(236). 2008.
American Association of Homes and Services for the Aging, American Seniors Housing Association, Assisted Living Federation of America, National Center for Assisted Living, and National Investment Center for the Seniors Housing & Care Industry. 2009. Overview of Assisted Living Facilities. Stratton Publishing and Marketing, Inc. Alexandria, VA.
ESRI 2009 Community Sourcebook of Zip Code Demographics, 23rd ed., ESRI Business Solutions.
MetLife Mature Market Institute. 2009. Market Survey of Long-Term Care Costs: The 2009 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services and Home Care Costs. http://www.metlife.com/assets/cao/mmi/publications/studies/ Accessed: January 2010.
National Center for Assisted Living, “Assisted Living Resident Profile,” 2009, website: www.ncal.org. Accessed: January 2010.
Oklahoma State Department of Health, “Directory of Oklahoma Licensed Long Term Care Facilities,” 2009, website: www.health.state.ok.us. Accessed: January 2010
Shelton, R.D., St. Clair, C., Doeksen, G.A., and V. Schott. 2003. A Systems Development Guide for Rural Assisted Living Facilities. Stillwater, OK: Oklahoma State University.
U.S. Bureau of the Census, 2010, website: www.census.gov. Accessed: July 2010.
U.S. Bureau of Economic Analysis, 2010 website: www.bea.gov.: Accessed: July 2010.
U.S. Department of Health and Human Services, Administration on Aging, Fact Sheet: Assisted Living. 2009, website: www.aoa.gov. Accessed: March 2009